Laurelhurst Neighbor 2 Neighbor Contact Form

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LN2N is a Laurelhurst neighbors mutual support group for Covid-19. We want to connect neighbors who can help - e.g. with grocery shopping - other neighbors who need to shelter at home because they are at high risk from the virus. All answers strictly private, only for use by LN2N and Laurelhurst Neighborhood Association (LNA). Please complete and click send. Contact LN2N.lead@gmail.com with questions. Or call John Liu, 510-847-0070.

Your Name. (Optional: your significant other's name too.) *

Your Street Address *

How Many Adults Live In Household

4 or more

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Anyone In Household Over 60 Years of Age? *

Yes, some but not all adults in household are 60 y/o or older

Yes, all adults in household are 60 y/o or older

Do You Need To Shelter At Home During Covid-19? (Due to age, medical conditions, doctor's advice, or other reasons.) *

Yes

Will You Need Help From Neighbors With Shopping / Other While Sheltering At Home? (Due to no-one in household or nearby available to help you.) *

Yes

If You Will Need Help, Please Explain: What Help?

How Many Children Under 10 In Household?

None

2 or more

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Any Medical Professional (MD, ND, RN, DO, etc) In Household? (Optional, if willing then details please)

Any Emergency Services / First Responder in Household? (Optional, if willing then details please)

Does At Least One Person In Household Drive And Have Consistent Access To A Car?

Yes

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Do You Know A Neighbor Who May NEED HELP From Neighbors To Avoid Exposure To Virus?

Yes

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If Yes, Please Tell Them About LN2N And Ask Them To Fill Out This Contact Form. (If they cannot access the form, please do it for them or tell us their name, address, and phone - IF they agree.)

Are You Willing To Help A Older / Medically Fragile Neighbor With Shopping? (Not forever - just temporarily.)

Yes

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Are You Interested In Being A Block Rep For LN2N? (Block reps will help match up neighbors who need help with nearby neighbors who want to help, so that no-one gets overlooked. Saying "yes" means you'd like to hear more about this: you're not committing.)

Yes

Clear selection

Are You Interested In Being A Quad Rep For LN2N? (Quad reps will help coordinate block reps. Saying "yes" means you'd like to hear more about this: you're not committing.)

Yes

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Your Email. (Optional, but lets us contact you)

Your Phone. (Optional, but lets us contact you)

Submit

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